The Ear

The ear has three main components; the outer ear, middle ear and inner ear. We are all familiar with the outer ear which comprises the pinna or auricle on the outside as well as the ear canal, a fine tube leading to the eardrum which in turn vibrates when it receives sound.

Hearing is one of our most important senses and our perception of the world involves the interpretation of the sounds which are all around us. Simple pleasures such as the sound of birds chirping, children laughing, conversation with loved ones and the enjoyment of music rely on a normally functioning hearing mechanism.

Our hearing is controlled by one of the body’s most complex organs, the ear, which converts sound into electrical impulses that travel to the auditory centres of our brain. Blockages in this pathway, such as from excessive earwax, can disrupt this mechanism and contribute to hearing loss.

Earwax

Cerumen, more colloquially known as earwax, is naturally produced by the wax-producing glands in the outer part of the ear canal.

Earwax contains a mixture of skin cells and waxy secretions from small sebum and cerumen producing glands. The texture of earwax is determined by our genetics; with some people having wet, soft earwax and others hard, rocky wax. (The genetics of earwax have even been used to help track human migration patterns!)

Earwax has properties which provide protection to the ear to reduce infection, it lubricates the canal and holds anti-bacterial properties.

How should earwax be removed?

Our ears are designed to be self-cleansing. So with time, earwax migrates from the inner ear canal to the external opening of our canal. Our everyday jaw movements of chewing and talking also aid the migration of wax.

Cotton buds should never be used to clean inside the ear canal! Cotton buds push earwax further into the ear canal causing the earwax to become trapped and impacted.

Unless you’re an ENT surgeon, you should never let anything smaller than your elbow into your ear canal!

What causes earwax to build up?

There are multiple factors which can contribute to the build-up of earwax within our ears.

Genetic factors which contribute to earwax build up include age, the type of earwax you produce, narrow ear canals and excessive hair follicles. Cotton bud usage and ear plugs can also contribute to earwax impaction.

Regular hearing aid users often face a similar problem as the earpiece of the hearing aid prevents the egress of wax and skin from the ear canal. Untreated, this can cause the hearing aid to become less effective over time. It is estimated that around 65% of over 65s have problems with excessive earwax. Excessive earwax and the hearing loss it can cause has been linked with cognitive impairment in the elderly.

Earwax build up occurs when the ear produces more wax or skin than it can naturally push out of the ear due to the above factors. The accumulation of wax and skin debris in the ear canal results in the impaction of wax due to the blockage of the ear canal.

Earwax build up can become harmful and present in a variety of different ways:

Hearing loss
Earache
Sensation of blockage
Tinnitus
Vertigo
Coughing

See My Treatments

Diagram of the right ear:

(From left to right) Ear canal with earwax, ear drum and delicate middle ear structures

Cotton buds should never be used to clean inside the ear canal!

Cotton buds push earwax further into the ear canal causing the earwax to become trapped and impacted.

Conditions disrupting natural earwax mechanism:

The following conditions disrupt the natural migration of skin and earwax out of the ear and are conditions often seen and treated by ENT surgeons in clinic:

Otitis externa aka outer ear infection:

A very itchy and painful infection of the ear canal associated with discharge from the ear and hearing loss

Eczema of the ear canal:

A common inflammatory skin condition can affect the ear canal causing itching and increased susceptibility to developing ear infections

Narrow or hairy ear canals

Leads to trapped dirt, wax and skin and prevent it from exiting the ear canal

Keratosis obturans:

A rare condition of the ear canal skin characterised by abnormal shedding of the skin lining and progressive narrowing of the ear canal

Mastoidectomy surgery / mastoid cavities:

Patients who have had this surgery need regular cleaning of the large cavity left behind by surgery

Which treatment does The Ear Specialist recommend?

We aim to provide the best standard of care using the latest technology. We therefore use the microsuction technique with endoscopic magnification to suction or gently probe out earwax rather than with a microscope. The endoscope offers our doctors an unparalleled view of the ear. This means our technique is more precise, more comfortable and with considerably less risk to the delicate structures of the ear and eardrum.

Microsuctioning is the gold-standard procedure that ENT surgeons use in practice. It is by far the safest procedure, well-tolerated and can be used in patients with many different conditions.

During the procedure we will also take before and after pictures of your ear canal and ear drum so you can see (and hear!) instant results of the treatment we have carried out. We may also carry out a recording of the procedure.

The Ear Specialist using endoscopic microsuctioning technique to safely remove earwax

What other treatments are there to remove ear wax and are they all the same?

The question of how to remove earwax dates back thousands of years!

Ancient remedies have varied from hot oil to soda mixed in honey wine to cucumber juice mixed with crushed rose leaves! Most will be familiar with olive oil and sodium bicarbonate drops that can commonly be used to soften wax but this doesn’t help with removal.

There are three other outdated techniques commonly used to remove earwax; ear candling, ear syringing and use of loupes to remove wax.